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Estimating the causal effects of private health insurance in Brazil: Evidence from a regression kink design

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  • Menezes-Filho, Naercio
  • Politi, Ricardo

Abstract

Despite having free access to the public health system, 25% of the Brazilian population have a private insurance plan, which is subsidized by the government by means of an income tax rebate. This paper explores this rebate to tackle the potential endogeneity between private insurance and the demand for health services, using the fiscal incentive as a source of quasi-experimental variation in insurance prices. We estimate the average effect of private insurance for the marginal individuals at the kink points by means of a nonseparable nonparametric regression model. Our data allow us to disentangle moral hazard from adverse selection effects and the results indicate that private insurance has a positive impact on the use of preventive services, health outcomes, physical exercises, and smoke quiting, and does not impact the use of nonpreventive health services, such as inpatient services and surgeries.

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  • Menezes-Filho, Naercio & Politi, Ricardo, 2020. "Estimating the causal effects of private health insurance in Brazil: Evidence from a regression kink design," Social Science & Medicine, Elsevier, vol. 264(C).
    • Handle: RePEc:eee:socmed:v:264:y:2020:i:c:s0277953620304779
    DOI: 10.1016/j.socscimed.2020.113258
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    1. Macinko, James & Seixas, Brayan V. & de Oliveira, Cesar & Lima-Costa, Maria Fernanda, 2022. "Private health insurance, healthcare spending and utilization among older adults: Results from the Brazilian Longitudinal Study of Aging," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
    2. Aline de Souza & Mônica Viegas Andrade & Kenya Valéria Micaela de Souza Noronha & Igor Viveiros Melo Souza, 2025. "Effect of age‐related premium readjustment on health insurance cancellation in Brazil: Regression discontinuity approach," Health Economics, John Wiley & Sons, Ltd., vol. 34(1), pages 3-17, January.
    3. Peng Yang & Zhiping Chen, 2023. "Optimal Private Health Insurance Contract towards the Joint Interests of a Policyholder and an Insurer," Mathematics, MDPI, vol. 11(10), pages 1-28, May.
    4. dos Santos, Anderson Moreira Aristides & Triaca, Lívia Madeira & Tejada, Cesar Augusto Oviedo, 2021. "Evolution of inequalities in health care use among older people in Brazil: Evidence for the period 1998–2019," The Journal of the Economics of Ageing, Elsevier, vol. 20(C).
    5. Aristides Dos Santos, Anderson Moreira & Triaca, Lívia Madeira & Leivas, Pedro Henrique Soares, 2023. "How is smoking distributed in relation to socioeconomic status? Evidence from Brazil in the years 2013 and 2019," Economics & Human Biology, Elsevier, vol. 49(C).

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